Impact of Progression of Diastolic Dysfunction on Mortality in Patients with Normal Ejection Fraction
Background—Diastolic dysfunction (DD) is an independent predictor of mortality in patients with normal left ventricular (LV) ejection fraction (EF). There are limited data however, on whether worsening of diastolic function is associated with worse prognosis.
Methods and Results—We reviewed clinical records and echocardiogram of consecutive patients with baseline echocardiograms between January 1, 2005, and December 31, 2009 that showed LVEF ≥55% and who subsequently had a follow-up echocardiogram within 6 to 24 months. Diastolic function was labelled as normal, mild, moderate or severe dysfunction. All-cause mortality was determined using the social security death index. Kaplan-Meier survival analysis and Cox regression analysis with proportional hazard model were performed to assess outcomes. A total of 1065 outpatients were identified (mean [SD] age, 67.9 [13.9] years, 58% male). Baseline DD was present in 770 patients (72.3%), with mild being most prevalent. On follow-up testing (mean [SD], 1.1 [0.4] years), 783 patients (73%) had stable, 168 (16%) had worsening, and 114(11%) had improvement in baseline diastolic function. 88 patients (8.3%) had decrease in LVEF to <55% and were more likely to have advanced DD (P=0.002). After a mean follow-up (SD) (from the second study) of 1.6 (0.8) years, 142 patients (13%) died. On multivariate analysis, a decrease in LVEF to <55% and any worsening of diastolic function were independently associated with increased risk of mortality (HR 1.78[1.10;2.85], p=0.02, and 1.78[1.21;2.59], p=0.003, respectively).
Conclusions—In patients with normal baseline LV ejection fraction, worsening of diastolic function is an independent predictor of mortality.
- Received September 6, 2011.
- Accepted December 12, 2011.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited